Oregon Public Broadcasting

Discussions in Congress this week are focused on finding more money to fund health care.

Oregon has  developed a fertile market for health care programs -- particularly for seniors. But as April Baer reports, the market could be in for some big changes as the health care system is retooled.

Pat Rieke put in over a decade as an insurance analyst. But now she has a weekly volunteer gig she just loves, helping people figure out what kind of Medicare plan they need.

Pat Rieke   “Some of them are looking for just the prescription drug part of the plan. Some are just looking for basic information because they’re turning 65.”

Rieke, a lively and petite woman who looks nowhere near 69. She’s logged on from the study of her house in the Ladd’s Addition neighborhood in Portland

Pat Rieke   “OK I’ve got mine marked on favorites, the official Medicare.gov website so we’ll just go there.”

I asked her to show me just how many options are out there for Medicare coverage in Oregon.

Pat Rieke  “I just stuck in a zip code -- that’s mine today. And it says there are 64 plans available in your area!”

The multitude of options are  private plans that provide alternatives to traditional government-run fee-for service Medicare. 

Imagine Medicare as a garden that Congress built up over the years, with different landscapers for each new program.

Traditional fee-for-service Medicare is a spacious lawn. But it's now adjoined by several new Medicare Advantage flower beds. 

Some beds sprout HMO-style services, others grow Preferred Provider options, with a slightly broader choice of doctors. But the  upkeep on the Medicare Advantage beds has started to attract  attention.

Barack Obama:   “...we should end overpayments to Medicare Advantage."

Last month, President Obama gave a speech to the American Medical Association, likening the government’s support of Medicare Advantage plans to subsidies.

Barack Obama: “Today, we are paying Medicare Advantage plans much more than we pay for traditional Medicare services. That's a good deal for insurance companies, but not the American people.”

The President wants to reduce reimbursements for these private plans down to the same levels as traditional fee-for-service Medicare.

If that happens, it will have consequences for Oregon, and its thriving garden of Medicare Advantage plans— especially in the  Third Congressional District.

Earl Blumenauer: “Medicare Advantage has the highest penetration in our community of any place in the country. We’re talking about thirty percent of Medicare recipients are using Medicare Advantage through private insurance companies.”

Congressman Earl Blumenauer says Oregon’s traditional Medicare reimbursements are low, because the state’s done a good job at keeping costs down.

If the reimbursements for privately-run plans are brought down into line with traditional Medicare payments, doctors in the Portland Metro area will get, on average, 26 to 30 percent less per patient.

The problems could be even more severe in rural areas, that have had a notoriously hard time getting doctors to take Medicare patients.

Part of what’s going on here is that Oregon’s garden has been running health care differently than the rest of the country.

Key decision-makers in House and Senate committees that are looking at health care changes come from states that spend big on health care, like California and New York.

Tricia Neuman is vice president and director of the Medicare Policy Project at the Kaiser Family Foundation.

Tricia Neuman “At the moment, Medicare Advantage savings are one component of a broad set of policy options being talked about in health reform. And there’s certainly a lot of horsetrading that seems to be occurring. How the horsetrading will sort itself out is a good question, but I do think there is general agreement that the current payment policy unsustainable.”

Neuman adds that's not to say there won't be room for negotiation on how the cuts are made.

Many within the system agree that Oregon's Medicare garden could stand some weeding. Volunteer Pat Rieke points out it's a real job matching clients with plans.

Pat Rieke "Frankly I think there's too many options, because nobody can handle 64!"

But Rieke says it's important to maintain enough plans to give her clients real choices.